Child Abuse and Neglect:Situation in the World
Jenny Gray OBEISPCAN Past President and Social Work Consultant
62nd Turkish National Pediatric Congress
International Workshop on Child Abuse and NeglectBelek/Antalya, 14 November 2018
UNCRC UN Convention on the Rights of the Child (CRC)
International/Regional treaties or protocols
Article 19: Right of the Child to freedom from all
forms of violence
General Comment 13: The Right of the Child to
Freedom from All Forms of Violence (2011)
(http://www2.ohchr.org/english/bodies/crc/docs/CRC.C.G
C.13_en.pdf)
The facts• Homicide – In 2012, homicide took the lives of about 95,000 children and adolescents – almost 1 in 5 of all homicide victims that year
• Physical punishment – 6 in 10 children regularly subjected to physical punishment by carers
• Bullying – > 1 in 3 students between the ages of 13 and 15 regularly experience bullying
• Forced sex –120 million girls < 20 years (about 1 in 10) have been subjected to forced sexual intercourse or other sexual acts at some point in their lives
• Intimate partner violence (IPV) – 1 in 3 adolescent girls worldwide have been the victims of emotional, physical or sexual violence committed by their intimate partners
Source: Hidden in Plain Sight: A statistical analysis of violence
against children. (2014) UNICEF.
Violence against children –
effects on health and well-being
Impact of maltreatment: Brief summary
The burden on the life of a child is potentially
extensive, with a major impact on the individual, on future family life, and is a burden on the community.
Many children who have been maltreated develop psychiatric and medical disorders at significantly
higher rates than non-victimised children.
The long-term negative health consequences of
extensive victimisation can last well into adult life, at risk of mental health and
medical disorders,
There is an associated impairment in various
aspects of cognitive, social and emotional
development. poorer educational achievements,
lower earnings risks of criminal activities.
Child and Family Training (2018)
Adverse Childhood Experiences
Studies on Adverse Childhood Experiences (ACEs):
Conclude that abuse and neglect during childhood may have long lasting and severe impacts on both later childhood and adult functioning
See: https://www.cdc.gov/violenceprevention/acestudy/
The costs of child maltreatment
Maria Santos Pais (2016) stated “… with relatively modest investments in proven strategies for violence prevention, a long-lasting difference can be made to protecting children from violence.”
The EU has calculated that “every euro invested in preventing violence produces a social return of 87 euros”
Maria Santos Pais (2013) makes the all important point that “In a time of austerity, investing in violence prevention is a question of good economics”
Sources: Maria Santos Pais (2013) Toward a world free from violence. Global study on violence against children. (p. xiv); Maria Santos Pais (2016) Annual report of the Special Representative of the Secretary-General on Violence against children (p. 5).
BUT …
While it is evident that low income countries face “huge
challenges, which compromise children’s well-being
and protection” …
Middle and high income countries ”are also grossly
lacking in resources…”
Source: World Perspectives on Child Abuse. 13th Edition (2018) Denver:
ISPCAN, p.10.
Resources Financial and human resources are required to
support work with children and families
Too often financial decisions are made without
considering the consequences for children: short
term financial gains can have very serious
consequences for children’s outcomes
Securing investment in early intervention can lead
to cost savings but the benefits for children take
time to be able to be demonstrated
End Violence
The Global Partnership to End
Violence Against Children
AGENDA 2030:ENDING VIOLENCE AGAINST CHILDREN
Responding to Agenda 2030’s
vision, goals and targets
End violence against children…
16.2
End abuse, exploitation, trafficking, and all forms of violence
against and torture of children
5.2 Eliminate all forms of violence against all women and girls in
public and private spheres, including trafficking, and sexual and
other types of exploitation
5.3 Eliminate all harmful practices, such as child, early and forced
marriage,
and female genital mutilation
8.7 Elimination of the worst forms of child labour, including slavery,
human trafficking, and recruitment and use of child soldiers,
and by 2025 end child labour in all its forms
4.a Provide safe, non-violent, inclusive, and effective learning
environments for all
4.7 Ensure that all learners acquire knowledge…[for] promotion of a
culture of peace and non-violence
…reduce the impact of violence in families, communities and all settings…
…and ensure access to fair and effective
institutions and to justice for all
16.1
Significantly reduce all forms of violence and related death
rates everywhere
11 Make cities and human settlements inclusive, safe, resilient and
sustainable
16.3
Promote the rule of law at the national and international levels,
and ensure equal access to justice for all
16.9
Provide legal identity for all, including birth registration
16.a
Strengthen relevant institutions… to prevent violence
Strategy
What is End Violence?14 -
INSPIRE
Investing in Children:
the European Child
Maltreatment
Prevention Action
Plan 2015 - 2010
Dinesh Sethi et al. Violence and Injury Prevention Programme
World Health Organisation Regional Office for Europe
WHO Regional Office for
Europe - overall goal
“to reduce the prevalence of child maltreatment by
implementing preventive programmes that address
risk and protective factors, including social
determinants”
Source: Investing in Children: the European Child Maltreatment
Prevention Action Plan 2015 - 2010
Related target
“To reduce the prevalence of child maltreatment
and child homicide rates by 20% by 2020”
Three objectives to reduce
maltreatment by prevention Make health risks such as child maltreatment more
visible by setting up information systems in
member states
To strengthen governance for the prevention of
child maltreatment through partnerships and multi-
sectorial action by developing national plans
Reduce risks for child maltreatment and its
consequences through prevention by strengthening
health systems in member states
Related WHO Europe publications
European report on preventing child maltreatment
Implementing child maltreatment prevention programmes: what the experts say
Measuring and monitoring national prevalence of child maltreatment: a practical handbook
Handbook for the development of national action plans on the prevention of child maltreatment
Key messages to policy makers and members of civil society
States have clear obligations to address child abuse
and neglect
Explicit polices and an associated action plan are
essential for the prevention of child maltreatment
Child maltreatment is not inevitable: It can be
prevented by taking the multi-sectorial, multi-
factorial public health approach to prevention
advocated in Investing in Children: the European Child
Maltreatment Prevention Action Plan 2015 - 2010
European status report on preventing child maltreatment (2018)
Progress on Objective 1: making child maltreatment more “visible”:
• Child homicide is decreasing across the Region, but
rates in low and middle-income countries are 1.6x
higher than high income countries
• Strong information systems and surveillance to inform
prevention are lacking in many countries e.g data from
child protection agencies and hospital admissions
• National surveys using standardized, validated
instruments to determine prevalence are lacking in
many countries
European status report on preventing child maltreatment
Progress on Objective 2: are countries developing national action plans to coordinate action against child maltreatment?
• Since 2013, 30% increase in proportion of countries with a national action plan to prevent child maltreatment
• But improvements are needed in setting clear objectives with measurable targets and ensuring plans are fully funded; also links are needed to related policies to prevent violence, poverty, gender inequality and non-communicable disease
• Countries are encouraged to extend and enforce legislation to ban corporal punishment in all settings
European status report on preventing child maltreatment
Progress on Objective 3: are countries implementing prevention programmes?
• 57% of countries have home-visiting programmes on a large scale
• Various types of parenting programmes are being implemented, with scope for improvement e.g. Programmes to prevent abusive head trauma are least widely implemented (10% on a large scale)
• 43% undertake programmes in primary schools to strengthen protective factors such as recognition of abuse and proactive disclosure to trusted adults. Countries need to evaluate their programmes they develop
• Substantial rise in proportion of countries implementing large scale services for prenatal assessment of risk of child maltreatment or intimate-partner violence – requires well trained staff
• Counties are urged to tailor prevention programmes to meet the needs of children with disabilities
There is strong evidence that improvement
in positive parenting, rather than
reductions in harsh or negative parenting, is the key factor mediating change in child behaviour problem behaviour
Reduction in punishment is a necessary but not sufficient condition for improvement, whereas positive parenting is a necessary change
Source: Fonagy P. et al., 2016
Summary of research on intervention
Positive Parenting: An essential element of violence prevention strategies
Providing parenting support through the first years of a child’s life is strongly supported by evidence and can improve parenting, reduce parental stress, enhance the resilience of children, and prevent child maltreatment.
Parenting programmes result in positive effects in low-, middle- and high-income countries and can be effective in reducing child maltreatment when applied as primary, secondary or tertiary interventions.
The promotion of positive non-violent parenting should therefore form a key element of each country’s strategies to prevent violence against children and improve their developmental outcomes.
Source: ISPCAN, 2016
Framework for intervention and prevention of child maltreatment
Maltreatment (all types) Long-term
outcomes
Prevention
before
occurrence
Prevention
of
recurrence
Prevention
ofimpairment
Universal Targeted
From: MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN. Interventions to prevent child
maltreatment and associated impairment. Lancet 2009;373:250-266.
Evidence-based interventions: 3 levels
Primary prevention i.e. prevention the occurrence of maltreatment
Secondary prevention i.e. prevention of recurrence
Tertiary prevention i.e. prevention of impairment to the health and development of children who have been maltreated
For further information see: Sethi D. et al. (eds) (2013) European report on preventing child maltreatment. Copenhagen: World Health Organization, Regional Office for Europe; Hardcastle K. A. et al (2015) Implementing child maltreatment programs: what the experts say. Copenhagen: WH0 Regional Office for Europe; National Institute for Health and Care Excellence. (2017) NICE guideline. Child abuse and Neglect. London: Author.
Focus of Interventions Child or young person
Parents/caregivers
Family
Perpetrator of abuse or neglect
Wider family
Community
Summary of evidence for the effectiveness of universal and selective programmes
Impact on Tested inEuropeanRegion?
Childmaltreatment
Risk factors
Universal programmes
Sexual abuse preventionprogrammes
◆ ✓
Media-based public awareness ❖ ✓
Abusive head trauma prevention ❖ ❖
Changing social norms ✓
Reducing the availability of alcohol ❖ ✓
Reducing poverty
Community interventions ❖
Preventing exposure to intimatepartner violence
Selective programmes
Home visiting ❖ ◆
Parenting programmes ❖ ◆ ✓
Multi-components preschoolprogrammes
❖ ❖ ✓
Enhanced paediatric care ❖ ❖
Support and mutual aid groups
From: Sethi D. et al. (eds) (2013) European Report on Preventing Child Maltreatment, p. 62.
The focus on the prevention of violence against children
• Has identified the importance of working with parents and caregivers
• The public health approaches to prevention of violence against children have identified various levels of prevention
- Primary
- Secondary
- Tertiary
Services to parents and caregivers should include all three levels
Recommendations for action on violence against
children
Prevention, prevention, prevention
• Global coordination
• Regional coordination
• National coordination
Specific role for professional societies: need to endorse and ensure mandatory violence against children training at the national available as part of core curriculum in their professional streams.
Cok tesekkur ederimThank you very much!
References Bentovim, A. & Gray J. (eds) (2016; 2017) Hope for Children and Families Intervention
Resources for practitioners. York: Child and Family Training.
Dubowitz H. (ed) (2018) World Perspectives on Child Abuse. Denver: ISPCAN. https://www.ispcan.org/learn/world-perspectives/13th-edition/
Fonagy, P, Cottrrell, D., Phillips J., Dickon, B., Glaser, D., Allison, E. (2015) What Works for Whom?. 2nd Edition. London: Guildford.
Gray, J., Jordanova Pesevska, D., Sethi, D., Ramiro Gonzalez, M.D. & Yon, Y. (2016) Handbook for the development of national action plans on the prevention of child maltreatment. Copenhagen: WH0 Regional Office for Europe.
Hardcastle K. A. et al. (2015) Implementing child maltreatment programs: what the experts say. Copenhagen: WH0 Regional Office for Europe.
ISPCAN (2016) Positive Parenting: ISPCAN Global Resource Guide. https://www.ispcan.org/wp-content/uploads/2017/04/Positive_Parenting_Report_Fi.pdf
MacMillan HL, Wathen CN, Barlow J, Fergusson DM, Leventhal JM, Taussig HN. (2009) Interventions to prevent child maltreatment and associated impairment. Lancet: 373:250-266.
References – contd. Maria Santos Pais (2013) Toward a world free from violence. Global study on violence against children, p.
xiv. http://srsg.violenceagainstchildren.org/sites/default/files/documents/docs/Toward%20a%20World%20Free%20from%20Violence.pdf
Maria Santos Pais (2016) Annual report of the Special Representative of the Secretary-General on Violence against children, p. 5. http://srsg.violenceagainstchildren.org/document/a-71-206_1484
Meinck, F., Steinert, J.I., Sethi, D., Gilbert, R., Bellis, M.A., Mikton, C., Alink, L., & Baban, A. (2016) Measuring and monitoring national prevalence of child maltreatment: a practical handbook. Copenhagen: WH0 Regional Office for Europe.
National Institute for Health and Care Excellence. (2017) NICE guideline. Child abuse and Neglect. London: Author.
Sethi D. et al. (eds) (2013) European Report on Preventing Child Maltreatment. Copenhagen: WHO Regional Office for Europe. http://www.euro.who.int/__data/assets/pdf_file/0019/217018/European-Report-on-Preventing-Child-Maltreatment.pdf
Seth D. et al. (eds) (2018) European status report on preventing child maltreatment. Copenhagen: WHO Regional Office for Europe.
UNICEF (2014) Hidden in Plain Sight: A statistical analysis of violence against children. New York: Author.